THE
MEDICAL EXAMINEE,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES. —NO. CVI.—OCTOBER, 18 53.
ORIGINAL COMMUNICATIONS.
On the Diseases and Injuries of Seamen. By G. R. B. Horner.
M. D., Surgeon U. S. Navy, Philadelphia.
A very rare case of abscess in the left parotid gland occurred
on board the Delaware in her voyage to Brazil. The patient
was a seaman of 38 years, who, without any known cause, was
seized with swelling and acute pain in the part, without any
constitutional symptoms for four days after his admission on the
sick-list. Fever then ensued, and was followed by a great in-
crease of pain and swelling. This soon extended itself to the
whole side of the face, and the lids of both eyes became tume-
fied so much as to intercept vision. Linseed poultices were at
first applied, and upon the extension of inflammation into the
surrounding parts, were mingled with a solution of super-acetate
of lead. Purgative pills were taken, the parts were scarified,
and suppuration having occurred on the sixth day, an incision
was made into the abscess with a lancet and a large quantity of
foetid pus let out which continued to flow for many days. In
the meantime the poultices were continued, and opium rubbed up
with vinegar was given to relieve pain. Fever was subdued
with the spiritus mindereri and tartar emetic, the blue pill was
taken at night and worked off with epsom salts or magnesia and
rhubarb. The abscess, however, refused to close; the neck and
left angle of the lower jaw became indurated and swelled, and
his constitution depraved. A bitter infusion and syrup of sarsapa-
rilla were prescribed as needed; lead water was injected into the
cavity formed beneath the ear, a lotion of sulphate of zinc was
used, the black wash was also injected and a seton passed
through the abscess from above downwards. An incision was
likewise made beneath the left eye to let out a collection of pus
formed there. He was put on a diet adapted to his condition,
and at first low, then nutritious. The bowels were kept open
by the purgatives mentioned, cream of tartar water, and castor
oil; and tone was given to his system by the sulphate of quinine dis-
solved in elixir of vitriol and water, and properly sweetened.
Under this treatment he was restored to health two months after
his admission.
An abscess of a still more obstinate kind, bearing a strong re-
semblance to that of the armorer, occurred in the above ship, and
was treated at the same time with the abscess just described.
But the duration of the former one was much longer, that being
continued a period of six months, and it was the result of a
scrofulous inflammation of the left hip joint, or morbus coxarius.
The subject of the affection was a sailor of small size, aged 22
years, who stated that he had fallen on the left hip six years
previously, and had hurt it so much as to have been lamed for a
week, but that afterwards lie suffered no inconvenience until just
before he was taken under treatment. Pain then came on in the
left groin and its glands began to swell. Two days subsequently
he had cough, general pains, and other signs of having caught
cold.
The ship at this time was lying in Hampton Roads ready to
sail, and only awaiting orders, and a number of her crew were
affected with catarrh. As the patient seemed only affected with
this, and had said nothing of his having once injured his hip
joint by a fall, he was given at first only a pectoral and a dose
of epsom salts and tartar emetic, and directed to use frictions
to the seat of pain with vol. liniment. A soap plaster was next
applied to the glands, which reduced their size, but the pain con-
tinuing, the parts beneath becoming tumid and indurated, two
blisters were put on in successsion. The swelling still increasing,
poultices were substituted, and excited suppuration three weeks
after his admission. By this time the swelling extended throughout
the groin and occupied the parts above and below Poupart’s liga-
ment. An incision was made into the swelling of the groin,
a profuse discharge of bloody pus took place, and in a few days
assumed a greyish hue. The nature of the disease having been
previously developed satisfactorily, the patient had been pre-
scribed the syrup of sarsaparilla twice a day in the dose of three
ounces. A month afterwards another incision had to be made
on the inside of the thigh, next the scrotum, to let out pus. The
blue pill was given, the syrup continued, and frictions were used
to relieve pain and stiffness of the thigh. He also took opiates
as required, and an infusion of cinchona and gentian, after hav-
ing used the syrup for more than a month. His bowels were
kept open by pills and castor oil; black wash was applied to the
abscess as a lotion, and when the former had closed, an issue was
made over the joint with caustic potash, and beans were put into
the issue formed to keep it running. Under this treatment the
affected parts healed kindly though slowly ; but by the twelfth of
December, at the time the ship had crossed the tropics and got
on the coast of Brazil, he had become pallid, emaciated and de-
bilitated, and besides had had an ulcer formed on the sacrum
from his having been bedridden two months. The left lower ex-
tremity was also soft, oedematous and swelled, the leg was flex-
ed on the thigh, and this on the pelvis, and Amesbury’s splint
■was applied to keep them extended, and prevent permanent flex-
ure and shortening of the limb. To remove swelling a bandage
was first applied around it from the foot upwards.
Notwithstanding all that was done for him, and his previous
improvement, he became still worse on our arrival at Rio, and
was seized with fever. The parts again swelled, suppuration
returned upon the re-application of a poultice to the groin, and a
spontaneous discharge of pus occurred at the first incision, through
a fistulous opening. The fever was relieved after this, and the
administration qf repeated doses of tartar emetic, each consist-
ing of the -g- of a grain in solution. Afterwards he took the qui-
nine mixture three times a day, and kept on the poultices as long
as necessary. On introducing a probe, the abscess was found to
reach several inches towards the anterior superior spinous process
of the ilium. But by a continuance of the treatment adopted the
patient again improved; the groin healed, and he gradually reco-
vered the use of the limb so far as to be able to walk about the
ship with a crutch. Perfect use of it was impossible, for so far as
could be ascertained, the head of the femur had been entirely
removed by caries, spontaneous dislocation had happened and
a false joint had been formed on the dorsum of the ilium.
The knee and foot were turned inwards as in accidental luxation,
the limb was shortened about three inches, and the patient was
barely able to touch the decks with the toes of the left foot. He
was, moreover, so unlucky as to again take cold on our arrival at
Montevideo, and to have the affected joint injured by concussion
with a shipmate. By these mishaps his recovery was re-
tarded, but in April he was discharged to duty, and being lame
was sent home during the following summer.
All the varieties of external or tegumentary ulcers I have
met with at sea, but the most numerous and difficult of cure were
the varicose, indolent and venereal. The first kind were uniformly
seated on one or both legs and near the enlarged veins, and the
second kind were generally on the same parts, and sometimes of
a scorbutic character, having been attended with puffiness and
lividness of the limbs, the formation of fungus and a strong dis-
position to slough, which displayed itself particularly in the La
Plata. The cause of this was thought to be as much owing to
improper aliment as the coolness and dampness of the climate,
rendered more injurious by the strong winds continually blowing
up the river from the southern Atlantic; for the ship’s crew "were
supplied abundantly with fresh provisions several times a week.
In the treatment of the varicose ulcers, uniform pressure was made
upon the limb with a spiral bandage and adhesive strips, nu-
merous metallic lotions and some ointment were applied, the
patient was kept at rest, the limb was elevated, and the consti-
tution kept in or restored to a sound condition. The same rules
were observed in treating indolent ulcers; the edges were kept
down by lunar caustic, pressure and scarification, and they were
washed generally with a solution of the sulph. of zinc, sulph.
of copper or nitric acid several times a day, or sprinkled with
powdered cinchona, which was often very efficient. On the
coast of Brazil this was most observed, and most practised, from
the general indolence there of all kinds of ulcers. Hence the
cases there were also treated by the free use of internal tonics,
among which the preparations of quinine were commonly prefer-
red. Of the ointments, the citrine, red precipitate and Turner’s
cerate were most efficacious. As in the treatment of abscesses,
the blue pill was employed, laxatives were given afterwards, and
the patients dieted according to their condition. When they
manifested scorbutic marks, lemonade was freely drank, and
some of the bitters or tonics were administered.
In the treatment of venereal ulcers, my uniform practice was
to apply the lunar caustic once or more, then to heal them up
with the black wash, or a solution of sulphate of copper or zinc,
and if this failed or was not effectual enough, a little mercurial
ointment was rubbed near the ulcers. Sometimes the blue pill
was taken, and in a few cases, when the ulcers sloughed, a solu-
tion of 3i or jii of nitric acid in 5viii. of water was applied with
certain success, though very severe. If buboes followed the
ulcers, they were if possible driven back by leeches or blisters,
but these frequently failed, and the latter were objectionable
from their inducing permanent induration of the skin as well as
thickening of it. My practice, therefore, was generally, to cause
suppuration by applying linseed poultices. But at Naples the
virus of syphilis was so active and violent, that it quickly im-
pregnated the system, acted like the poison of a viper on the
parts, producing chancres and buboes in rapid succession, and I
found that the best practice was to induce their absorption or
suppuration by frictions with mercurial ointment in the course of
the absorbents leading towards them. When constitutional
symptoms followed they were combated with the syrup and
decoction of sarsaparilla, and sometimes with blue mass in alter-
ative doses. Other mercurial preparations were not employed
at all, and salivation was never induced, yet very few instances
of secondary syphilis happened, and no case was uncured, nor
■were any bones made carious, as under the old mercurial mode
of treating syphilitic diseases, when patients were made to spit
by the quart, according to John Hunter’s practice. One of the
most remarkable cases of secondary syphilis was that of an
officer who contracted two chancres at Malta. They were
healed with the.nitrate of silver, black wash and lead water,
without any apparent constitutional taint; no buboes formed, and
yet six weeks after he was first treated for chancres, and some
days after he had returned to duty, a venereal ulcer formed in
both tonsils. Ilis diathesis was highly nervous and sanguine,
the ulcers were irritable and inflamed, spread extensively, were
very hard to cure, and resisted the healing virtues of several
gargles, as of borax, sage tea and honey, alone, and united
with tincture of myrrh. When these gargles had failed, a
solution of five grains of the nitrate of silver, to an ounce
of water was substituted, and applied once or oftener every
day with a mop. This medicine hid the desired effect, and
was gradually increased to 10 grains, the patient was put on
low diet, took five grains of blue mass every night, and & de-
coction of radix sarsaparillae §iv, senna 5i, extract of liquorice
the same, extract of sarsaparilla ~i, loaf sugar -viii, in a gallon
and a half of water, which was boiled down a third. The next
day after taking the blue pill he took a dose of powdered
rhubarb. Afterwards some sassafras and mezereon were added
to the decoction, but proved irritating to the throat and were
omitted. By the above treatment the ulcers were healed in
about a month, but the fauces continued inflamed, and a scaly
eruption appeared on the scalp, spread downwards over the back,
and formed copper colored blotches over all the body and
limbs. Not even the penis was exempted, and it became covered
at the lower part with continuous scabs. This eruption was as
obstinate as the ulcers in the throat, which reappeared in a short
time, again healed up, and broke out again four months after
they first appeared. The solution of nitrate of silver was perse-
veringly applied to them, and at last effected a cure with the
help of constitutional remedies. In addition to those named,
hot bathing in fresh and sea water, was used every day, seidlitz
powders were substituted for rhubarb after the blue pill, and the
skin kept perspirable by dissolving four grains of tartar emetic
in a gallon of the diet drink. Ilis condition was soon improved
by this change of treatment, his throat and skin assumed their
natural state and he was restored permanently to duty early in
August. His recovery was a subject of joy to himself, medical
attendants, and colleagues, who had been performing his duties
so long, and would have probably been obliged to do so inde-
finitely, had he been treated according to the old routine and
thoroughly mercurialized; for his irritable, sanguine temperament
and partly scrofulous habit, would certainly have been aggra-
vated by such practice, and incurable ulcerations and caries been
the probable consequences. His case illustrates too the very
great importance of healing chancres immediately. His were
not healed, I understand, from his living on shore when they
broke out, and their having been allowed to attain a large size
before the medicines mentioned were applied.
Of primary syphilis many cases were treated, and most of
them occurred in the Mediterranean, whose chief ports abound
with every form of venereal diseases. Hence the crews of vessels
allowed to go frequently on shore at them, invariably suffered
much from them. That of the United States, consisting of 480
men, proved that fact, for about a fifth were infected during her
cruise ending in the fall of 1838. Of these, a fourth had pri-
mary and secondary syphillis; and sixty, gonorrhoea. In the
case of the latter disorder, both on board her and other vessels,
as well as on land, I have found that the safest and surest plan
of treatment was to combine local with constitutional treatment.
This was ascertained by using each method seperately on distinct
classes of the patients, learning the average time it took to cure
each class, and then doing the same with regard to a third class,
treated after the joint method. The average number of days
for the last class was fourteen; that of the others much more.
Hence the general method of treatment adopted afterwards was
to confine the patients to their hammocks, open their bowels with
castor oil in preference to any saline purgatives which might
render the urine more irritating; and to give gum water or flax-
seed tea, sometimes with a grain or two of tartar emetic to a
quart, chiefly to create slight qualmishness and prevent indulgence
in food. This was strictly farinaceous, and commonly fluid.
Leeches were applied under the urethra, or poultices to the
whole part, warm bathing was used, and injections of the super-
acetate of lead, from three to five grains, prescribed. This was
gradually increased, now and then joined with the sulphate of
zinc, or substituted by the nitrate of silver much diluted. This
latter I have employed first, but have seen it produce such
violent effects, as- not to be able to recommend it at an early
stage and in a large quantity. To relieve chordee, camphor in
pills of five grs., and frictions under the urethra with mercurial
ointment were frequently employed, the first article acting as an
anodyne and sedative, the latter producing absorption of the co-
agulable lymph, preventing the expansion of the urethra from
corresponding with that of other parts. Internally, we likewise
gave powdered cubebs, in the doze of 3i. two or three times a
day, the oil of the same article, and balsam of copaiva in its pure
state, mixed with sugar, gum arabic, and water, or made into
pills with calcined magnesia, which is a very excellent method
of using the copaiva, as it prevents nausea, corrects acidity, and
enables the stomach to retain a much larger quantity. Hence
my patients preferred the pills to any of the balsam mixtures.
It mattered not whether they were combined or not with laudanum,
tr. of lavender, or sweet spirits of nitre, and especially with the
last, which is so ethereal as to cause the eructations to be in-
tolerable to some persons. By the above treatment they were
cured, pleasantly, and without stricture, but the former was
varied when required, and if orchitis supervened, the affected
part was leeched, poulticed, washed with cool astringent lotions
until restored to its pristine dimensions, and when these
remedies failed, the iodine ointment was successfully applied ;
but it occasions such excessive pains after the cuticle is stripped
off by it, that few patients will submit to its reapplication.
Cutaneous Affections.
Besides the diseases mentioned, some of the most common
met with were scabies, herpes, impetigo, acne, and urticaria.
Between the tropics the miliaria occurred frequently, scarlatina
north of them, and variola in every climate. Pemphigus was of
rare occurrence every where; no case of measles was seen on board
of any ship. Erysipelas was very rare, and the same may be
stated respecting other cutaneous affections not noticed. Of
scabies every grade was met with, those only affecting the
fingers and arms, as well as those spreading over all parts of the
body, and simulating diseases of a different kind. This was pro-
perly ascribed to neglect, want of cleanliness, and allowing
patients to remain affected with itch without being reported, or
from their keeping aloof from medical advice and using no reme-
dial agents, until the skin had become thoroughly irritated by
the animalculae, and was covered with scabs. From this circum-
stance they may be attributed to some other cause, and are liable
to be thought owing to some of the eruptive disorders. In warm
climates from constant excitement kept up in the skin, this
blunder is most apt to be made, particularly when the patients
keep aloof and apply for no relief until forced by excessive
itching. But by careful examination of the hands for the de-
tection of the small vesicular pimples commonly found in itch
between the fingers; by the fact of others having the complaint
on board, and the absence of constitutional symptoms, we may
satisfy ourselves of its existence in the persons being examined.
In the treatment of those affected, a speedy cure was uni-
formly obtained by me from the use of sulphur ointment rubbed
on all parts affected twice or three times a day, and the cure of
some cases was hastened by giving as often from Ji to 3ii of the
flowers or lac sulphuris in molasses. A solution of the iodide of
potash as a lotion is also efficacious, and is preferred by some
from its not tainting the air, but I decidedly prefer the sulphur.
For the hands, the most cleanly mode of applying it was to work
up the flowers with soap, and to use it as the ordinary. To the
body the ointment was applied twice or three times a day, and
in some cases when the whole skin was infected, I generally
gave the flowers in the dose of gi in molasses, as often. To re-
lieve the itching immediately, and the inflammation occurring
in bad cases, a solution of the super-acetate of lead was used as a
lotion. Change of clothes, as much cleanliness as could be
observed while using the ointment, and separation from the unin-
fected, were likewise enjoined, and by strict observance of this
treatment the disease was uniformly soon cured and stopped
from diffusion. Besides animalculae causing scabies, I have
frequently known seamen to be greatly annoyed by vermin of
two kinds, the common louse and crab. For the cure of the
complaint caused by the first, the razor, and a thorough washing
with soap and water, prescribed by the officers of the line, are
usually employed, though as much for disgrace as a remedy.
But for that complaint as well as for the one occasioned by the
other vermin, none can be used with greater certainty than
mercurial ointment. By rubbing it in the hair, or on the parts
affected, a few times, it will always act as a deadly poison to the
vermin, at once kill them and remove the itching.
Herpetic eruptions were met with at long intervals, and were
mostly of a mild kind, which soon healed by application of
the lunar caustic, or citrine ointment; but some cases were not
cured until treated constitutionally. The severest case I ever
saw was that of a young muscular, plethoric seaman in the
Mediterranean, who had had an attack four years before. His
whole body was covered with the eruption, in widely spread or
circumscribed patches, of a bright red hue, and throwing off thin
scales. His scalp was affected also, and the eruption on it be-
came pustular. He was twice on the sick list, the first time for
three months, the second for four, and was each time cured with
great difficulty. The remedies employed for the purpose were
ol. ricini, epsom salts, sulphur and cream of tartar, to relieve the
costiveness preceding the disease, the compound decoction of
sarsaparilla, blue mass, minute doses of corros. sublimate in the
former, the warm bath, and various lotions and ointments. Of
the last named, the red precipitate and citrine were the most
useful. Of the lotions, one made of corrosive sublimate, from
one to two grains in an ounce of water, was by far the best, and
during the several terms of treatment the cure was not effected
until it had been applied. The eruption then soon began to
wither; and when cured, no other relapse occurred to my know-
ledge. Like treatment locally was best for the ordinary ring-
worm, herpes zoster or shingles, acne, and impetigo. For urti-
caria, if induced by improper drinks or diet, as fish, sour fruits,
and red wine of Minorca, emetics and cathartics were prescribed, of
which epsom salts and tartar emetic to produce a double effect
of purging and vomiting, or magnesia to act as an antacid and
purgative, were preferred. For urticaria induced by heat of
weather, or by excessive exercise, no application was comparable
to aqua ammoniae applied with a sponge to the affected parts.
Though stimulating and pungent, it gives instantaneous relief,
and hardly needs reapplication. It produces a like effect in other
eruptions and external inflammations—erythematous, erysipel-
atous, and miliary ; and even in gouty inflammation of the feet,
I have used it with great success. At the same time that it re-
moved this it kept up such excitement of the parts as to prevent
it from becoming retrocedent. The action of ammonia is cer-
tainly very peculiar; though it stimulates, it also cools, seems to
have the power of causing a disgorgement of the capillary
vessels by inducing their contraction, and of producing a seda-
tive action in them, and thus to relieve inflammation. Ammonia,
moreover, by its rapid evaporation, carries off a great deal
of caloric from the parts whereon it is applied, and by that
means too acts remedially. But care must be taken that it be
not of full strength, and is diluted with water appropriately to
the case under treatment. Otherwise excoriation and unneces-
sary pain may be caused. When this is intense, some spirits of
wine, brandy, or whiskey added to the ammonia increase its
efficacy.
Scarlatina was seldom encountered, and it always happened,
in the United States, during the winter, and on the eve of de-
parture. There was no reason to believe it originated on board
ship, but that it was brought from shore. In its nature it differed
as it does on land. Some cases were mild, attended with slight
fever and eruption; others were accompanied with high excite-
ment at first, then by great prostration. Such was the fact with
a seaman of the Brandywine at New York, who died there of
scarlatina. In him it was of the most inflammatory kind, in the
commencement. His pulse was very full, strong and rapid,
v. s. was demanded, but soon after it his system sank, delirium
came on, putrid ulceration of the throat occurred, sordes col-
lected on the teeth, and he died on the fifth or sixth day after he
was taken sick. His death, however, may be in part ascribed to
his being overlooked on the second day after his admission on the
list, from his having kept in an obscure place, not applying for
further attention, and from the very great number of other
patients to be prescribed for during the intensely cold weather
we were then suffering. Most of the other cases which occurred
were mild, attended 'with little or no fever, with a white furred
tongue, having red papillae projecting through its fur, and slight
inflammation of the skin and throat, and required only laxatives,
mild diaphoretics, and astringent gargles, as of alum, borax,
sage tea, and tincture of myrrh, to be cured.- But after the ship
got to sea, another man, who had his throat very much inflamed
and swelled, suddenly sank into a typhoid state and died. He
had been unwell a month, was convalescing it appeared, but
being confined on the berth deck with a number of persons ill of
typhus fever, he evidently was infected with it, had symptoms
of pneumonia, and was so much surprised when he heard that the
captain’s cook, in a cot near his, had just died of the former disease,
that he lost all hope, repeated what he heard, «the French cook is
dead,” sank upon his pillow and died within an hour. He was
a novice at sea, and not possessed of the fortitude and pecu-
liar buoyancy of spirit belonging to sailors. Of all eruptive
disorders, the most common, the most afflicting among them, is
small pox. In all places, in all climes, they suffer from it, and
of six ships of war in which I have cruised, it infected the
crews of three. Three of them escaped by good luck, if not by
precautionary means, but one, the United States, got it on board
three times, once before she left New York in 1836, and twice
during her cruise in the Mediterranean during that and the fol-
lowing year. The first time, only one case happened, from its
being sent to the naval hospital as soon as detected. By the
same precaution the Brandywine had previously got rid of the
disease, at the same place, and the Delaware was equally for-
tunate in doing so, at Rio de Janiero. In the last instance, for
want of a better place, the patient was put beneath a tarpolin
tent pitched for him on a large rock, called Rat Island, opposite
the city, and there treated until well. A man who had had small
pox attended him, no one else than he and myself were allowed
to go on the rock, and though the patient had had the primary
fever and staid in the ship four days afterwards, no other person
got the disease. This may be attributed to its having been
modified by vaccination, of which he had a good mark on his left
arm, or to the persons who were near him having been protected,
or being insusceptible otherwise. He himself caught the disease
merely from being on some barrels with a negro man whom he
found on the island of Enxados, and conversed with for some
time. The negro was convalescing, and had so little the appear-
ance of having had small pox, that my patient did not think of
danger, and allowed him to sit only a foot or two from him; nor
did the latter make known these facts until two days had elapsed
after he was seized with the primary symptoms, the pustules had
been developed and strict enquiry was made of him regarding
exposure to the complaint. Hence the cause of his not having
been sooner sent out of the vessel and quarantined.
She also had a like lucky escape from contagion after her arri-
val in the Mediterranean. A store-ship brought a case of small
pox into the harbor of Mahon, and anchored near hei’ and held com-
munication. The case was reported to Commodore Morris, as one
of a doubtful character; I was sent to see it and found the patient
as scabby as Lazarus, and could not refrain from expressing my
astonishment that there should be any doubt of the nature of the
case. It was reported to the Commodore, intercourse was prohibited
with the store-ship, and though her commander denied the man had
small pox, at my recommendation, he was sent to the Lazaretto,
in charge of a man protected by vaccination, but who being not en-
tirely so, became infected with varioloid, and had a moderate
attack. This proved positively the character of the complaint
and it was further proved by inquiry, and ascertaining that a
case of varioloid had occurred in the above ship, a few days after
she left home. In what manner she obtained pratique at Gib-
raltar, and again at Port Mahon is still a mystery, and it is un-
certain whether it was owing to connivance on the part of the
quarantine officers, their being uninformed of the cases which
had occurred, or to the nature of the disease not being under-
stood by the medical officer and others of the vessel infected.
By keeping the patients in the Lazaretto until well, and then,
according to my custom, by burning all things belonging to
them, the squadron escaped greater contamination. Of the
good effects of separating the sick from the well, and of the con-
trary from not doing it, proof was afforded on board the United
States. While lying in the port of Alexandria a marine on
guard at the star-board gangway saw a shore boat approaching
with several Egyptians in it. One had marks on his face of re-
cent small pox, the boat was hailed and ordered to keep off, but
she got to the foot of the ladder before she did so, and within
fifteen or more feet of the sentinel. A week after, the squadron
left port he was taken sick of varioloid, got well in a few days,
but infected a seaman with genuine small pox. Fortunately the
ship arrived at Mahon before it attacked him, he was sent to the
Lazaretto, where he staid three weeks, and had the disease in
the confluent form. Yet by observing the precautions mentioned
no one got the disease from him.
Of the bad effects of not excluding patients ill of it from the
sound, an instance happened during the subsequent winter at
Smyrna. A mulatto seaman in watering the frigate there, got
small pox from some of the natives at the fountain. At the
same time he was seised with a violent catarrh, or influenza,
then universal in the crew, and had the other complaint so
masked that he was treated for the latter several days, and until
by the approach of a lamp, near his face, the eruption was
discovered by me on his forehead. As soon as this occurred, he
was put out of the sick bay, which was in the bow of the vessel,
and hung in his cot on the outside. From there he was soon
transferred after some difficulty in getting permission, to the
gun deck, and near the fore hatch. Deeming that an im-
proper place for him to remain in, as many men hung their
hammocks near him, and having in vain recommended his being
sent on shore, I applied for the poop cabin which was vacant,
to accommodate him. The commander tried to prove that the
disease was more apt to spread from there, than the gun deck,
and resisted all persuasion. At last on my informing him that
he must then take the responsibility, and I would send a letter
to that effect, he yielded and the man was put into the cabin.
It was too late, he died in a day or two, and was thrown through
a port hole into the Egean sea. A sailor who had slept next to
him on the gun deck, got the natural small pox from him, and
before and after the ship reached Mahon, and we were able to
separate him from the crew, and send him to the Lazaretto, ten
others, eight men and two officers, were infected—From a pre-
cisely similar circumstance, the small pox got on board the Ma-
cedonian on the eve of her departure from Brazil, in September,
1828. Two merchant seamen, at Rio, came to her for passage
home. One 'was Freeman, a mulatto, and in two or three days
afterwards, on his presentation at the table of Surgeon B. Tick-
nor, who was prescribing for the sick on the gun deck, he was
found to be feverish, to have his forehead swollen and covered with
variolous pimples. The surgeon forthwith got up, and reported
the case to Commodore Biddle, who sent the patient without
delay to the city hospital. The frigate left port, the south east
trade wind soon arose, swelled her sails, and wafted her home-
ward ; she bounded over the waves, dashing the snow white
foam far from her sides. All hearts were glad, the merry
sailors in the evening collected on the forecastle, and danced to the
inimitable music of Miller, the sailor fiddler, and Jack Williams,
a lively young negro, capered a jig to the admiration of every
bystander. The next evening the same merriment was repeated,
but the day after, an invalid, James Grant, who was consump-
tive, and had been sent from the corvette Boston to go home in
the frigate, was seized with small pox. He was in no manner
protected. He had neither been inoculated nor vaccinated, and
most unluckily had had his cot hung in the sick bay next to the
hammock of the infected mulatto. This apparently trifling inci-
dent proved a most disastrous one. Grant had the disease in
the most terrible manner, the pocks on his face perfectly co-
alesced, became almost black, and his whole body seemed to
have become decomposed, such was its foetor. It was in vain
that he was put behind a screen, abaft on the starboard side
of the gun deck, and there only approached by the nurses and
medical officers. The whole ship was tainted, the air even in
her fore chains, outside of her, smelt of him, and every one in
her liable to the contagion became affected. Inoculation was
resorted to for protection as soon as the scabs could be had.
On the 14th day he died, was quickly wrapped up, and lashed
in his cot, with four 181b. shot in the foot of it, was pushed over a
gun, and thrown into the sea, through one of the nearest ports.
No one save attendants witnessed the burial, and after all the arti-
cles used by him had been thrown after him, the deck was
cleaned and sprinkled with vinegar.
After such care we hoped no other case would happen. The
crew the day after had become as jolly as ever, and Miller’s
music was again heard. A sudden stop a second time was put
to it. On the fifth day after Grant’s death, Moses Nicholas,
cook of the cockpit, was seized with the fatal disease, which
was so violent that the eruption was suppressed, his skin
became covered with numerous little pimples like those of flee
bites, and he died on the seventh day, vomiting and purging
blood. While he was gasping for breath, the jolly Williams, a
fellow cook, who had the primary fever, got out of his hammock,
sat upon a shot.box, and seeing his friend expiring, cried out,
“ a fair word to you Moses !”—returned soon to his hammock ; in
a few days he died of the fell disorder, and was likewise consigned
to the deep. Five others shared the same fate, some after a
short illness, others after a protracted struggle. Of the former
was Samuel Parker, a marine, whose skin became purple, put
forth no pustules, and lost its cuticle in large flakes. Of the
latter was Alfred Curtis, a sergeant of marines, who lingered a
month, and died after suffering greatly from an enormous
sloughing ulcer at the lower part of his loins, which had reached
a large size before he complained of it, and it was discovered.
Previously he had had ulceration of the left leg, and subse-
quently a large abscess burst beneath the chin. Altogether
forty of the crew and officers took small pox in some form, from
the mishap of taking Freeman on board. Of that number, seven-
teen had it naturally, three had it modified by inoculation, and
twenty by vaccination. Some of these persons had it very
lightly ; one of them would not keep from duty, nor come on the
sick list, and several had merely slight fever and a few pocks
which soon disappeared. Of the crew more than a hundred
were inoculated as soon as the virus could be got, and only one
of that number had the disease. But several afterwards had
headache, pain in the loins, and immense scabs upon the parts
inoculated. That on the arm of the first lieutenant, the present
Commodore Salter, continued to grow until it was about the
size of a half dollar, and yet he had no observable constitutional
affection. The effects upon myself were simply languor and
uneasiness in the loins. No one of those protected died, and
those who were so by vaccination had the mildest symptoms.—
Desquamation in the latter came on soonest, and, in the worst
cases, was completed in a few hours. Most of the natural cases
were confluent, but one of them, that of Alexander Neale, or
young Turner, seaman, was remarkable for the very small number
of its pustules, and their great perfection. He got well, and when
with me in the Delaware, twelve years afterwards, retained no
visible marks of small pox, which cannot be asserted of many
who had only had varioloid. The last person who took the
disease in any form was admitted on the sick list upon the 30th
of September, or the fifteenth after the death of Grant, Thirty
of the cases occurred within ten days from it, and within twenty
from the time of the eruption being well developed upon him.—
We may therefore conclude that the period of incubation was on
an average ten days, though sometimes not so long, as in him-
self, who shewed the eruption nine days after it appeared upon
Freeman, unless the former caught the contagion from the latter
during the primary period before the eruption was detected.
Treatment.—From the oppressed condition of the patients,
and the malignant type assumed by the complaint in some of
them, depletion was mostly avoided; no blood was drawn from
any one, the bowels were gently evacuated with castor oil or
epsom salts, and calcined magnesia; an emetic was given in four
of the cases, three of which were cured; cream of tartar in so-
lution for a drink, pills of calomel, pulvis antimonialis and
opium were administered frequently. Sometimes the last was
left out, and spirits of nitre and camphor were used. To re-
move the very acute pain in the loins, suffered in most cases,
laudanum in large doses was prescribed. When the sick became
prostrated, port wine sangaree, and an infusion of powdered
cinchona, flavored with elixir vitriol and tincture of cinchona,
and having a fourth part of whiskey added to the water, were
taken. The diet was farinaceous, consisting of rice and tapioca,
chiefly, and cooling drinks were allowed. As much attention
as possible was paid to the general comfort of the sick, their
mouths were freed of the viscid saliva collected in them and the
fauces; their clothes and bedding were changed,their bodies wash-
ed ; lead water and dressings applied to sore parts, and the
three medical officers besides the care they took of the sick
during the day, divided the night into as many watches, and at-
tended to them during it, the surgeon taking the first one, assist-
ant surgeon Henry S. Coulter, and myself, the mid and morning.
But the sick were so crowded, on the gun deck, where all the
worst cases were hung in cots and hammocks, to escape the heat
on the berth deck, rendered greater by the ship being between
the tropics, and crossing the equator, that it was impossible they
could all be made comfortable. The want of enough good
bedding, the necessity of using linen almost as coarse as sail
cloth, and a tempest of three days duration, from the south west,
and near the line, rendered that more difficult. We were also
not provided with as good a supply of medicines, provisions, and
other necessaries for the sick, as we should have been, had such
an epidemic been anticipated.
In this way, then, we must account for the large proportion
of deaths among those affected with natural small-pox; which, in-
cluding that of Freeman, who was said to have died on shore,
amounted to nine, or fifty per cent. In the treatment of the
cases which subsequently in various stages fell under my spe-
cial care, the rule observed was to remove the most prominent
symptoms as they occurred. If action was high, blood was drawn,
generally, or locally, the bowels were well evacuated with ep-
som salts alone or combined with tartar-emetic. This was given
afterwards, in the quantity of one-eighth of a grain with half an
ounce of the spiritus mindereri every hour during the con-
tinuance of the primary and secondary fever, anodynes, as laud-
num and sulphate of morphia in the dose of one-eighth of a grain
were taken to procure sleep and relieve pain; and lemonade,
cream of tartar in solution, rice and barley water, and flaxseed
tea, were drank freely. Rice boiled in milk, soup, arrow-root,
and other farinaceae were allowed for diet.
In most cases a weak solution of acetate of lead in water
was applied to the eyes to remove swelling and diminish the in-
flammation; gargles of stewed molasses and vinegar, borax, sage
tea and honey, and of tincture of myrrh and alum and water,
were used sometimes, and applied to the fauces to subdue irrita-
tion and remove the swelling, as well as to clear them of the
accumulations of mucus and sordes. The whole body was sponged
frequently with warm water, the feet bathed in hot, the pocks,
especially those on the face, were early lanced and evacuat-
ed, the face was kept covered until well with a rag dipped in cam-
phorated oil, to protect the former from air and light, the mouth
was well cleansed, and the apartments of the sick were as
well ventilated as necessary. From the severe catarrhal symp-
toms attending the cases originating at Smyrna, expectorants
were given in them, and a solution of liquorice and tartar emetic
was found best adapted to them.
Severe local pains were relieved by leeches, and these were
frequently applied to the temples and loins, which were al-
ways much affected in the worst cases of small pox.
By the above treatment, altered according to circumstances,
the seaman, Wm. Reed, who caught the disease at Smyrna, was
the only one who died, and his death may properly be ascribed,
in part, to the small-pox having been preceded and accompanied
with the influenza, which fixed itself on the lungs and larynx,
masked the more dangerous affection; and rendered a greater loss
of blood necessary than would have been drawn had he been af-
fected with small-pox alone. He was bled three times within the
first four days of his illness, had six leeches applied to the la-
rynx, twelve to the small of the back, and sixteen to the tem-
ples, to relieve him of delirium. Altogether he lost from the arm
forty-six ounces of blood, and about seventeen from leeches,
reckoning that each one drew half an ounce, which is a mod-
erate allowance for them. Notwithstanding the loss of so much
blood, the inflammatory symptoms kept up almost without inter-
mission; the face and throat swelled, the pustules formed and
were confluent, on every part of his body, and he lived ten days
after he was taken undei’ treatment.